Employment Application

Employment ApplicationVision Design

"*" indicates required fields

Step 1 of 5

Applicant Information

Date*

Name*

First Middle Last

Email Address*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone Number*

Cell Phone Number*

Are you legally eligible for employment in the U.S.A.?*

Yes

Would you work:*

Full Time

Part Time

Were you previously employed by us?*

Yes

Salary Desired*

On what date will you be available for work?*

Hours available:*

Employment Desired

Position you are applying for*

Please choose from our open positions.

Summarize special skills and qualifications:*

Employment Experience

Start with your present or most recent job.

Employment 1

Employer*

Supervisor*

Address*

Street Address City State ZIP Code

Phone*

Job Title*

Dates of Employment*

Reason for Leaving*

Summarize the type of work performed and job responsibilities:*

Employment 2

Employer*

Supervisor*

Address*

Street Address City State ZIP Code

Phone*

Job Title*

Dates of Employment*

Reason for Leaving*

Summarize the type of work performed and job responsibilities:*

Employment 3

Employer*

Supervisor*

Address*

Street Address City State ZIP Code

Phone*

Job Title*

Dates of Employment*

Reason for Leaving*

Summarize the type of work performed and job responsibilities:*

May we contact the listed employers?*

Yes

Yes, except my current employer

Other

Please explain if you indicated that we cannot contact employers*

Personal Reference

References, 3 Required*

Name

Occupation

Address

Phone Number

Please add three references other than relatives. Click the + to add additional references.

Upload Resume

Max. file size: 50 MB.

Accepted file types: pdf, doc, docx, jpg, jpeg.

How did you learn about this job opportunity?

(LinkedIn, Facebook, newspaper, MCN site, etc.)

Please Read and Sign Below

The facts set forth in my application for employment are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
I hereby understand and acknowledge that any employment relationship with this organization is of an “at will” nature, which means that an employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in my discharge. I understand, also, that if I am employed, I am required to abide by all rules and regulations of the employer.

Signature of applicant*

Type in your full name

Date*

Note to applicants: HAVE YOU RECEIVED A JOB DESCRIPTION INFORMING YOU ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING AND A REVIEW OF THE ACTIVITIES INVOLVED IN SUCH JOB OR OCCUPATION?*

Yes

If yes, are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?*

Yes

If Semcac employs you, you will be required by Federal Law to complete the Immigration and Naturalization Service Form I-9 to verify your identity and employment eligibility.
***Equal Opportunity Employer***

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Serving Southeastern Minnesota Counties

Serving Dodge, Fillmore, Freeborn, Houston, Mower, Winona & Steele with limited services in Olmsted, Goodhue, Rice, Wabasha & Waseca

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Employment Application

Applicant Information

Employment Desired

Education: High School

Education: College/University

Education: Other

Employment Experience

Employment 1

Employment 2

Employment 3

Personal Reference

Please Read and Sign Below